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Maximising the potential of reablement
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2013
- Pagination:
- 46
- Place of publication:
- London
This guide is based on research and practice evidence about the effectiveness and cost-effectiveness of reablement. Reablement is meant to help people accommodate illness or disability by learning or re-learning the skills necessary for daily living. The guide looks at: physical, psychological and social needs; commissioning and joint working; staff development; outcomes; support services; people with dementia and reablement; and support for people once their programme of reablement is over in order to maintain progress. (Edited publisher abstract)
Older people's experiences of cash-for-care schemes: evidence from the English Individual Budget pilot projects
- Authors:
- MORAN Nicola, et al
- Journal article citation:
- Ageing and Society, 33(5), 2013, pp.826-851.
- Publisher:
- Cambridge University Press
Cash-for-care schemes offering cash payments in place of conventional social services are becoming commonplace in developed welfare states; however, there is little evidence about the impact of such schemes on older people. This paper reports on the impact and outcomes for older people of the recent English Individual Budget (IB) pilot projects (2005–07). It presents quantitative data on outcome measures from structured interviews with 263 older people who took part in a randomised controlled trial and findings from semi-structured interviews with 40 older people in receipt of IBs and with IB project leads in each of the 13 pilot sites. Older people spent their IBs predominantly on personal care, with little resources left for social or leisure activities; and had higher levels of psychological ill-health, lower levels of wellbeing, and worse self-perceived health than older people in receipt of conventional services. The qualitative interviews provide insights into these results. Potential advantages of IBs included increased choice and control, continuity of care worker, and the ability to reward some family carers. However, older people reported anxieties about the responsibility of organising their own support and managing their budget. For older people to benefit fully from cash-for-care schemes they need sufficient resources to purchase more than basic personal care; and access to help and advice in planning and managing their budget. (Publisher abstract)
Is case management effective in reducing the risk of unplanned hospital admissions for older people? A systematic review and meta-analysis
- Authors:
- HUNTLEY Alyson L., et al
- Journal article citation:
- Family Practice, 30(3), 2013, pp.266-275.
- Publisher:
- Oxford University Press
Background. Case management is a collaborative practice involving coordination of care by a range of health professionals, both within the community and at the interface of primary and secondary care. It has been promoted as a way of reducing unplanned admissions in older people. Objective. The objective was to systematically review evidence from randomized controlled trials regarding the effectiveness of case management in reducing the risk of unplanned hospital admissions in older people. Methods. Eighteen databases were searched from inception to June 2010. Relevant websites were searched with key words and reference lists of included studies checked. A risk-of-bias tool was used to assess included studies and data extraction performed using customized tables. The primary outcome of interest was enumeration of unplanned hospital admission or readmissions. Results. Eleven trials of case management in the older population were included. Risk of bias was generally low. Six were trials of hospital-initiated case management. Three were suitable for meta-analysis, of which two showed a reduction in unplanned admissions. Overall, there was no statistically significant reduction in unplanned admissions [relative rate: 0.71 (95% confidence interval, CI: 0.49 to 1.03)]. Three trials reported reduced length of stay. Five trials were of community-initiated case management. None showed a reduction in unplanned admissions. Three were suitable for meta-analysis [mean difference in unplanned admissions: 0.05 (95% CI: −0.04 to 0.15)]. Conclusions. The identified trials included a range of case management interventions. Nine of the 11 trials showed no reduction of unplanned hospital admissions with case management compared with the same with usual care. (Publisher abstract)
The effectiveness of local authority social services' occupational therapy for older people in Great Britain: a critical literature review
- Authors:
- BONIFACE Gail, et al
- Journal article citation:
- British Journal of Occupational Therapy, 76(12), 2013, pp.538-547.
- Publisher:
- Sage
This literature review systematically selected, critically appraised, and thematically synthesized the post 2000 published and unpublished evidence on the effectiveness and cost effectiveness of occupational therapy interventions for older people in social care services. Identified themes established: the localized nature of social care services for older people; organizational and policy impacts on services, and factors influencing effectiveness and cost effectiveness. Although occupational therapists are increasingly involved in rehabilitation and reablement, there is a continuing focus on equipment and adaptations provision. A high level of service user satisfaction was identified, once timely occupational therapy services were received. Overall, occupational therapy in social care is perceived as effective in improving quality of life for older people and their carers, and cost effective in making savings for other social and healthcare services. However, the complex nature of social care services makes it difficult to disaggregate the effectiveness of occupational therapy from other services. (Edited publisher abstract)
Severe vision and hearing impairment and successful aging: a multidimensional view
- Authors:
- WAHL Hans-Werner, et al
- Journal article citation:
- Gerontologist, 53(6), 2013, pp.950-962.
- Publisher:
- Oxford University Press
Purpose: Previous research on psychosocial adaptation of sensory-impaired older adults has focused mainly on only one sensory modality and on a limited number of successful aging outcomes. We considered a broad range of successful aging indicators and compared older adults with vision impairment, hearing impairment, and dual sensory impairments and without sensory impairment. Design and Methods: Data came from samples of severely visually impaired (VI; N = 121), severely hearing-impaired (HI; N = 116), dual sensory-impaired (DI; N = 43), and sensory-unimpaired older adults (UI; N = 150). Participants underwent a wide-ranging assessment, covering everyday competence, cognitive functioning, social resources, self-regulation strategies, cognitive and affective well-being, and 4-year survival status (except the DI group). Results: The most pronounced difference among groups was in the area of everyday competence (lowest in VI and DI). Multigroup comparisons in latent space revealed both similar and differing relationship strengths among health, everyday competence, social resources, self-regulation, and overall well-being, depending on sensory status. After 4 years, mortality in VI (29%) and HI (30%) was significantly higher than in UI (20%) at the bivariate level, but not after controlling for confounders in a multivariate analysis. Implications: A multidimensional approach to the understanding of sensory impairment and psychosocial adaptation in old age reveals a complex picture of loss and maintenance. (Publisher abstract)
Computerised cognitive behavioural therapy for depression and anxiety with older people: a pilot study to examine patient acceptability and treatment outcome
- Authors:
- McMURCHIE William, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(11), 2013, pp.1147-1156.
- Publisher:
- Wiley
The study aimed to determine the acceptability and treatment outcome of using Beating the Blues (BTB) with older people (65+ years). Specific aims included identifying the treatment uptake and drop-out rate, and describing the role of basic demographics in therapy uptake. Fifty-eight participants who were experiencing symptoms of depression were recruited from Older People Community Mental Health Teams across Tayside, Scotland. They were given a free choice of receiving treatment as usual (TAU) plus BTB (TAU + BTB) or TAU alone. All participants completed demographic questionnaires and a range of outcome measures at baseline, 2 months after baseline (end of treatment) and 3 months after baseline (follow-up). Thirty-three participants (56.9%) opted to receive BTB and reported having more experience and confidence using a computer than those who declined BTB. Twenty-four participants (72.7%) went on to complete all eight BTB sessions. Statistical analysis found significant differences between the two treatment groups, with the TAU + BTB group showing greater improvements in their symptoms of depression and anxiety than the TAU group by the end of treatment and at follow-up. Furthermore, the TAU + BTB group had a significantly higher percentage of participants who met criteria for clinically significant improvement in their symptoms of depression by the end of treatment and at follow-up. The results of this initial pilot study provide evidence that BTB may offer an acceptable and effective treatment option for older people. (Edited publisher abstract)
A randomised controlled trial of the Home Independence Program, an Australian restorative home-care programme for older adults
- Authors:
- LEWIN Gill, et al
- Journal article citation:
- Health and Social Care in the Community, 21(1), 2013, pp.69-78.
- Publisher:
- Wiley
The study investigated the effectiveness of the Home Independence Program (HIP), a restorative home-care programme for older adults, in reducing the need for ongoing services. Participants included 750 older adults referred to a home-care service for assistance with their personal care, and received HIP or ‘usual’ home-care services. Service outcomes were compared at 3 and 12 months. Data were analysed by ‘intention-to-treat’ and ‘as-treated’. The intention-to-treat analysis showed at 3 and 12 months that the HIP group was significantly less likely to need ongoing personal care. Both groups showed improvements on the individual outcome measures over time with the only significant differences being found at 12 months for Instrumental Activities of Daily Living (IADL) in the as-treated analysis. Despite no difference between the groups over time in their overall ADL scores, a significantly smaller proportion of the HIP group required assistance with bathing/showering, the most common reason for referral, at 3 and 12 months. The results support earlier findings that participating in a short-term restorative programme appears to reduce the need for ongoing home care. The authors concluded that the implementation of such programmes throughout Australia could substantially offset the projected increase in demand for home care.
Five hours a day: systemic innovation for an ageing population
- Author:
- KHAN Halima
- Publisher:
- NESTA
- Publication year:
- 2013
- Pagination:
- 66
- Place of publication:
- London
Sets out thoughts on the impact of ageing on society and what that means in terms of innovation. It makes the case for a systematic look at how we live in an ageing society, to create new models of living and working, with a priority on the issues which have most impact on older people's lives. It finds there is a big gap between the focus of current ageing innovations and what older people actually want. It suggests that the factors that matter most to older people are: to have a sense of purpose – feeling useful and valued; to have a sense of well-being - living as well as possible with health conditions, being physically active and emotionally resilient; and to feel at home, independent and connected to others. The report identifies four ways in which the current approach to innovation in ageing is not supporting this vision: Social innovation lags behind technological innovation; defining ageing by what it is not; over-relying on top-down structural change; and lack evidence of what works. It highlights the need for innovation areas such as: mobilising community support for vulnerable older people - between family, friends, neighbours and communities; new markets with better adapted products and services and commissioning for outcomes; widespread use of personal budgets alongside traditional provider budgets; co–production as the norm for enabling people to live well with long–term conditions; and good application of technology to enable older people to age well, using devices and platforms that are assistive, responsive, affordable and evidence–based. (Edited publisher abstract)
A framework for understanding outcomes of integrated care programs for the hospitalised elderly
- Authors:
- HARTGERINK Jacqueline M., et al
- Journal article citation:
- International Journal of Integrated Care, 13(4), 2013, Online only
- Publisher:
- International Foundation for Integrated Care
Integrated care is a new strategy to enhance the quality of care for hospitalised elderly. Current models do not provide insight into the mechanisms underlying integrated care delivery. This article provides a framework to identify the underlying mechanisms of integrated care delivery in order to increase understanding between the relation between structure and outcomes. The overall aim is to improve the quality of care delivery and eventually patient outcomes. First, the cognitive components of the framework are outlined. These components consist of mechanisms that alter the way of thinking by professionals delivering care to older patients. Next the behavioural components are explained, which consist of mechanisms that explain how professionals actively share and combine patient information from various sources. An example of an application of the evaluation model for an integrated care programme for hospitalised and vulnerable older people is then provided. The following aspects are discussed: organisational context; care delivery by interdisciplinary teams; team context; health service delivery; quality of life for elderly patients. Interprofessional collaboration among professionals is considered to be critical in integrated care delivery due to many interdependent work requirements. Effective integrated care programmes combine the interacting components of care delivery. These components affect professionals’ cognitions and behaviour, which in turn affect quality of care. Insight is gained into how these components alter the way care is delivered through mechanisms such as combining individual knowledge and actively seeking new information. (Edited publisher abstract)
Tracking your preventative spend: a step-by-step guide
- Author:
- WILKES Laura
- Publisher:
- Local Government Information Unit
- Publication year:
- 2013
- Pagination:
- 28
- Place of publication:
- London
This toolkit helps councils to have a clearer understanding of how much of their budget is spent on prevention, how this contributes to the delivery of outcomes and what this means for increasing their activity towards early action programmes. It sets out the five steps to mapping and analysing spend: establishing a project sponsor and steering group; identifying and agreeing aims, objectives and scope of the project; understanding the outcome; mapping preventative services for the chosen outcome; and analysing and mapping budgets. It covers the practical steps taken and the outputs and challenges of each step. The toolkit draws on work carried out by the British Red Cross with the LGiU and Mears to support Camden Council to track their preventative spend against one of the council’s key outcomes from the Adult Social Care Outcomes Framework: to keep older people living independently for longer. The toolkit provides a useful resource for councils, health and wellbeing boards and clinical commissioning groups. (Edited publisher abstract)